Interphalangeal joint dislocation
Updates to Article Attributes
Interphalangeal joint dislocations are common upper extremity dislocations, and although considered minor injuries by many can result in significant disability.
Pathology
Most dislocations of the interphalangeal joints are due to hyperextension. The proximal interphalangeal joints are the most commonly involved and in the vast majority of cases the dislocation is dorsal 1.
The proximal interphalangeal joints are mobile and stability is largely due to ligamentous support: collateral ligaments, volar plate, capsule and central slip of the extensor tendon 2. The volar plate, which is confluent with the periosteum of the phalanges is key in maintaining joint stability and prevents hyperextension. In the majority of dorsal dislocations it is damaged, and may be associated with a small avulsion fracture 1-2. Collateral ligaments most commonly tear in the mid-substance, but can on occasion also result in an avulsion fracture 2.
Isolated dislocations of the distal interphalangeal joints are rare and usually are associated with avulsion fractures of the terminal extensor tendon or flexor digitorum profundus which insert into the base of the distal phalanges 2.
Radiographic features
Plain films are in almost all cases sufficient for the diagnosis. Ultrasound and/or MRI are reserved for assessment of ligamentous and tendinous structured in selected cases.
Plain films
The diagnosis is usually self evident provided adequate views are obtained and so long as the joint has not been reduced prior to imaging.
Reporting checklist
In addition to stating that a dislocation is present a number of features should be sought and commented upon 1-2:
-
dislocation: direction is predictive of the ligamentous structures likely to be damageddorsal: most common, and associated with volar plate damagelateral/medial: collateral ligamentsvolar: uncommon, and associated with central extensor slip damage
-
associated injuries-
fracturesavulsion fracture: comment on % of articular surface involved
open injury (gas in the soft tissues, usually clinically obvious)foreign bodies
-
Treatment and prognosis
Dislocations need to be reduced, preferably under a digital block 2. Most dorsal dislocations can be treated conservatively, even if they are associated with a small avulsion fracture (<25% of articular surface), provided they appear stable post reduction 2. Buddy splinting or an extension-block splint usually suffice 1-2.
In the rare instance of a volar dislocation, the central extensor slip is assumed to be avulsed. Immobilisation in extension either with splinting or with K-wires is required for adequate healing 1-2.
If avulsion fractures are large (>25% of the articular surface) then they usually require internal fixation 2.
Practical points
In addition to stating that a dislocation is present a number of features should be sought and commented upon 1-2:
-
dislocation: direction is predictive of the ligamentous structures likely to be damaged
- dorsal: most common, and associated with volar plate damage
- lateral/medial: collateral ligaments
- volar: uncommon, and associated with central extensor slip damage
-
associated injuries
-
fractures
- avulsion fracture: comment on % of articular surface involved
- open injury (gas in the soft tissues, usually clinically obvious)
- foreign bodies
-
fractures
-<p><strong>Interphalangeal joint dislocations</strong> are common <a href="/articles/upper-extremity-dislocations">upper extremity dislocations</a>, and although considered minor injuries by many can result in significant disability. </p><h4>Pathology</h4><p>Most dislocations of the interphalangeal joints are due to hyperextension. The proximal interphalangeal joints are the most commonly involved and in the vast majority of cases the dislocation is dorsal <sup>1</sup>. </p><p>The proximal interphalangeal joints are mobile and stability is largely due to ligamentous support: collateral ligaments, volar plate, capsule and central slip of the extensor tendon <sup>2</sup>. The volar plate, which is confluent with the periosteum of the phalanges is key in maintaining joint stability and prevents hyperextension. In the majority of dorsal dislocations it is damaged, and may be associated with a small avulsion fracture <sup>1-2</sup>. Collateral ligaments most commonly tear in the mid-substance, but can on occasion also result in an avulsion fracture <sup>2</sup>. </p><p>Isolated dislocations of the distal interphalangeal joints are rare and usually are associated with avulsion fractures of the terminal extensor tendon or flexor digitorum profundus which insert into the base of the distal phalanges <sup>2</sup>. </p><h4>Radiographic features</h4><p>Plain films are in almost all cases sufficient for the diagnosis. Ultrasound and/or MRI are reserved for assessment of ligamentous and tendinous structured in selected cases. </p><h5>Plain films</h5><p>The diagnosis is usually self evident provided adequate views are obtained and so long as the joint has not been reduced prior to imaging. </p><h6>Reporting checklist</h6><p>In addition to stating that a dislocation is present a number of features should be sought and commented upon <sup>1-2</sup>:</p><ul>- +<p><strong>Interphalangeal joint dislocations</strong> are common <a href="/articles/upper-extremity-dislocations">upper extremity dislocations</a>, and although considered minor injuries by many can result in significant disability. </p><h4>Pathology</h4><p>Most dislocations of the interphalangeal joints are due to hyperextension. The proximal interphalangeal joints are the most commonly involved and in the vast majority of cases the dislocation is dorsal <sup>1</sup>. </p><p>The proximal interphalangeal joints are mobile and stability is largely due to ligamentous support: collateral ligaments, volar plate, capsule and central slip of the extensor tendon <sup>2</sup>. The volar plate, which is confluent with the periosteum of the phalanges is key in maintaining joint stability and prevents hyperextension. In the majority of dorsal dislocations it is damaged, and may be associated with a small avulsion fracture <sup>1-2</sup>. Collateral ligaments most commonly tear in the mid-substance, but can on occasion also result in an avulsion fracture <sup>2</sup>. </p><p>Isolated dislocations of the distal interphalangeal joints are rare and usually are associated with avulsion fractures of the terminal extensor tendon or flexor digitorum profundus which insert into the base of the distal phalanges <sup>2</sup>. </p><h4>Radiographic features</h4><p>Plain films are in almost all cases sufficient for the diagnosis. Ultrasound and/or MRI are reserved for assessment of ligamentous and tendinous structured in selected cases. </p><h5>Plain films</h5><p>The diagnosis is usually self evident provided adequate views are obtained and so long as the joint has not been reduced prior to imaging. </p><h4>Treatment and prognosis</h4><p>Dislocations need to be reduced, preferably under a digital block <sup>2</sup>. Most dorsal dislocations can be treated conservatively, even if they are associated with a small avulsion fracture (<25% of articular surface), provided they appear stable post reduction <sup>2</sup>. Buddy splinting or an extension-block splint usually suffice <sup>1-2</sup>. </p><p>In the rare instance of a volar dislocation, the central extensor slip is assumed to be avulsed. Immobilisation in extension either with splinting or with <a href="/articles/k-wire">K-wires</a> is required for adequate healing <sup>1-2</sup>. </p><p>If avulsion fractures are large (>25% of the articular surface) then they usually require internal fixation <sup>2</sup>. </p><h4>Practical points</h4><p>In addition to stating that a dislocation is present a number of features should be sought and commented upon <sup>1-2</sup>:</p><ul>
-</ul><h4>Treatment and prognosis</h4><p>Dislocations need to be reduced, preferably under a digital block <sup>2</sup>. Most dorsal dislocations can be treated conservatively, even if they are associated with a small avulsion fracture (<25% of articular surface), provided they appear stable post reduction <sup>2</sup>. Buddy splinting or an extension-block splint usually suffice <sup>1-2</sup>. </p><p>In the rare instance of a volar dislocation, the central extensor slip is assumed to be avulsed. Immobilisation in extension either with splinting or with <a title="K-wires" href="/articles/k-wire">K-wires</a> is required for adequate healing <sup>1-2</sup>. </p><p>If avulsion fractures are large (>25% of the articular surface) then they usually require internal fixation <sup>2</sup>. </p>- +</ul>
References changed:
- 3. Martin L. Lazarus. Imaging of Athletic Injuries of the Upper Extremity, An Issue of Radiologic Clinics of North America - E-Book. (2013) ISBN: 9781455747061 - <a href="http://books.google.com/books?vid=ISBN9781455747061">Google Books</a>
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